GUMAL-IN, ELISHA GRACE D.

BSN-IA

MA’AM JASMIN RAMOS

HEALTH ASSESSMENT

POSTER OF THE ABDOMINAL CAVITY

ABDOMINAL REGIONS

STRUCTURE OF ABDOMEN

Right Hypochondriac

The right hypochondriac region contains the right portion of the liver, the gallbladder, the right
kidney, and parts of the small intestine.

Left Hypochondriac

The left hypochondriac region contains part of the spleen, the left kidney, part of the stomach,
the pancreas, and parts of the colon.

Epigastric

The epigastric (above stomach) region contains the majority of the stomach, part of the liver,
part of the pancreas, part of the duodenum, part of the spleen, and the adrenal glands. This
region pushes out when the diaphragm contracts during breathing.

Right Lumbar

The right lumbar region consists of the gallbladder, the left kidney, part of the liver, and the
ascending colon.
Left Lumbar

The left lumbar region consists of the descending colon, the left kidney, and part of the spleen.

Umbilical

The umbilical region contains the umbilicus (navel), and many parts of the small intestine, such
as part of the duodenum, the jejunum, and the illeum. It also contains the transverse colon
(the section between the ascending and descending colons) and the bottom portions of both
the left and right kidney.

Right Iliac

The right iliac region contains the appendix, cecum, and the right iliac fossa. It is also
commonly referred to as the right inguinal region. Pain in this area is generally associated with
appendicitis.

Left Iliac

The left illiac region contains part of the descending colon, the sigmoid colon, and the left illiac
fossa. It is also commonly called the left inguinal region.

Hypogastric

The hypogastric region (below the stomach) contains the organs around the pubic bone. These
include bladder, part of the sigmoid colon, the anus, and many organs of the reproductive
system, such as the uterus and ovaries in females and the prostate in males.

ABDOMINAL QUADRANTS

Right Upper Quadrant

The right upper quadrant contains the right portion of the liver, the gallbladder, right kidney, a
small portion of the stomach, the duodenum, the head of the pancreas, portions of the
ascending and transverse colon, and parts of small intestine. Pain in this region is associated
with infection and inflammation in the gallbladder and liver or peptic ulcers in the stomach.
Left Upper Quadrant

The left upper quadrant is the location of the left portion of the liver, part of the stomach, the
pancreas, left kidney, spleen, portions of the transverse and descending colon, and parts of the
small intestine. Pain in this region is associated with malrotation of the intestine and colon.

Right Lower Quadrant

In the right lower quadrant sits the cecum, appendix, part of the small intestines, the right half
of the female reproductive system, and the right ureter. Pain in this region is most commonly
associated with appendicitis.

Left Lower Quadrant

The left lower quadrant houses the majority of the small intestine, some of the large intestine,
the left half of the female reproductive system, and the left ureter. Pain in this region is
generally associated with colitis (inflammation of the large intestine) as well as pelvic
inflammatory disease and ovarian cysts in females.

THE THREE TYPES OF ABDOMINAL PAIN

Visceral Pain

Visceral pain is directly related to the organ involved. The majority of organs do not have an
abundance of nerve fibers, so the patient might experience mild or less severe pain that is
poorly localized. It’s important to understand this does not mean the patient is experiencing a
mild or less severe condition.

Characteristics:

 Less severe pain

 Poorly localized
 The pain is usually dull or aching and constant or intermittent

Parietal Pain

Parietal pain occurs when there is an irritation of the peritoneal lining. The peritoneum has a
higher number of sensitive nerve fibers, so the pain is generally more severe and easier to
localize. The patient will typically present in a guarded position with shallow breathing. This
minimizes the stretch of the abdominal muscles and limits the downward movement of the
diaphragm, which reduces pressure on the peritoneum and helps ease the pain.

Characteristics:

 More severe pain

 Easily localized
 The pain is usually sharp, constant and on one side or the other

Referred Pain

Referred pain is visceral pain that is felt in another area of the body and occurs when organs
share a common nerve pathway. For this reason, it is poorly localized but generally constant in
nature. An example is a patient with liver problems that experiences referred pain in the neck
or just below the scapula.
Characteristics:

 Poorly localized
 The pain is usually constant

WEB ASSIGNMENTS

PEPTIC ULCER DISEASE

An “ulcer” is an open sore. The word “peptic” means that the cause of the problem is due to
acid. Most of the time when a gastroenterologist is referring to an “ulcer” the doctor means a
peptic ulcer.

The two most common types of peptic ulcer are called “gastric ulcers” and “duodenal ulcers”.
These names refer to the location where the ulcer is found. Gastric ulcers are located in the
stomach. Duodenal ulcers are found at the beginning of the small intestine (also called the
small bowel) known as the duodenum. A person may have both gastric and duodenal ulcers at
the same time.

Symptoms

Many people with ulcers have no symptoms at all. Some people with an ulcer have belly pain.
This pain is often in the upper abdomen. Sometimes food makes the pain better, and
sometimes it makes it worse. Other symptoms include nausea, vomiting, or feeling bloated or
full. It is important to know that there are many causes of abdominal pain, so not all pain in the
abdomen is an “ulcer”.

The most important symptoms that ulcers cause are related to bleeding.

Bleeding from an ulcer can be slow and go unnoticed or can cause life-threatening hemorrhage.
Ulcers that bleed slowly might not produce the symptoms until the person becomes anemic.
Symptoms of anemia include fatigue, shortness of breath with exercise and pale skin color.

Bleeding that occurs more rapidly might show up as melena – jet black, very sticky stool (often
compared to “roof tar”) – or even a large amount of dark red or maroon blood in the stool.
People with bleeding ulcers may also vomit. This vomit may be red blood or may look like
“coffee grounds”. Other symptoms might include “passing out” or feeling lightheaded.
Symptoms of rapid bleeding represent a medical emergency. If this occurs, immediate medical
attention is needed.

Causes/Risk Factors

The two most important causes of ulcers are infection with Helicobacter pylori  and a group of
medications known as NSAIDs.

Helicobacter pylori (also called H. pylori or “HP) is a bacterium that lives in the stomach of
infected people. The understanding that H. pylori can cause ulcers was one of the most
important medical discoveries of the late 20th century. In fact, Dr. Barry Marshall and Dr. J.
Robin Warren were awarded the 2005 Nobel Prize in Medicine for this discovery.

People infected with H. pylori are at increased risk of developing peptic ulcers. When a person
is diagnosed with an ulcer, testing for H. pylori is often done. There are a number of tests to
diagnose H. pylori and the type of test used depends on the situation.
People with ulcers. who are infected with H. pylori. should have their infection treated.
Treatment usually consists of taking either three or four drugs. The drug therapy will use acid
suppression therapy with a proton pump inhibitor (PPI) along with antibiotic therapy and
perhaps a bismuth containing agent such as Pepto-Bismol. H. pylori can be very difficult to
cure; so it is very important that people being treated for this infection take their entire course
of antibiotics as prescribed.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are a group of medications typically used to

treat pain. There are many drugs in this group. A few of these include: aspirin (Bayer ®),
ibuprofen (Motrin®, Advil®), naproxen (Aleve®, Naprosyn®), ketorolac (Toradol®) and oxaprozin
(Daypro®). NSAIDs are also included in some combination medications, such as Alka-Seltzer ®,
Goody’s Powder® and BC Powder®.

Acetaminophen (Tylenol®) is NOT an NSAID and is therefore the preferred non-prescription

treatment for pain in patients at risk for peptic ulcer disease.

NSAID use is very common because many are available over the counter without a
prescriptionand therefore they are a very common cause of peptic ulcers. NSAIDs cause ulcers
by interrupting the natural ability of the stomach and the duodenum to protect themselves from
stomach acid. NSAIDs also can interfere with blood clotting, which has obvious importance
when ulcers bleed.

People who take NSAIDs for a long time and/or at high doses, have a higher risk of developing
ulcers. These people should discuss the various options for preventing ulcers with their
physician. Some people are given an acid suppressing PPI. These drugs can prevent or
significantly reduce the risk of an ulcer being caused by NSAIDs.

There are many myths about peptic ulcers. Ulcers are not caused by emotional “stress” or by
worrying. They are not caused by spicy foods or a rich diet. Certain foods might irritate an ulcer
that is already there, however, the food is not the cause of the ulcer. People diagnosed with
ulcers do not need to follow a specific diet. The days of ulcer patients surviving on a bland diet
are a thing of the past.

Diagnosis

The most typical way for ulcers to be diagnosed is by a procedure called an EGD. EGD stands
for EsophagoGastroDuodenoscopy. An EGD (also called “upper endoscopy”) is performed by
inserting a special lighted camera on a flexible tube into the person’s mouth to look directly into
the stomach and the beginning of the small bowel. This flexible camera carefully inspects the
most likely areas for ulcers to be located. Ulcers identified during an EGD may be
photographed, biopsied and even treated, if bleeding is present.

Another way ulcers were diagnosed in the past was with an x-ray test called an “upper GI
series”. An upper GI series involves drinking a white chalky substance called barium, and then
taking a number of x-rays to look at the lining of the stomach. Doctors can see the ulcers on
the x-rays when they have barium in them.

Today, the preferred method for diagnosing ulcers is with an EGD given the flexible camera is
better able to detect even small ulcers and because it allows for potential treatment at that time
if the ulcer is bleeding. An upper GI series can miss small ulcers and also does not allow direct
treatment of an ulcer.
Treatment

The way that ulcers are treated depends on a number of features. Nearly all peptic ulcers will
be treated with a proton pump inhibitor (PPI). PPIs are powerful acid blocking drugs that can
be taken as a pill or given in an IV. Often, the potent IV form is used if a patient is hospitalized
with a bleeding ulcer. There are six PPIs available in the United States. These are omeprazole
(Prilosec®, Zegerid®), lansoprazole (Prevacid®), pantoprazole (Protonix®), rabeprazole
(Aciphex®), esomeprazole (Nexium®), and dexlansoprazole (Dexilant®). There are very few
medical differences between these drugs.

Sometimes duodenal ulcers (not gastric ulcers) will be treated with H2 blockers. H2 blockers are
another type of acid reducing medication. Common H2 blockers are ranitidine (Zantac ®),
cimetidine (Tagamet®), famotidine (Pepcid®) and nizatidine (Axid®).

An important part in treating ulcers is by identifying what caused them Patients with ulcers
caused by NSAIDs should talk to their doctor about other medications that can be used to treat
pain.

If the person is infected with H. pylori this infection should be treated. Completing the full dose
of antibiotics is very important. Just as important, is making sure that the infection is gone.
There are number of ways to do this. Generally, a blood test is not a good way to test if the
infection is gone. The doctor who treated the infection can recommend the best way to do the
“test of cure”.

When someone has an ulcer that has bled significantly, treatment might be done at the time of
EGD. There are a number of techniques that can be performed during an EGD to control
bleeding from an ulcer. The gastroenterologist might inject medications, use a catheter to
cauterize the ulcer (burn a bleeding vessel shut) or place a small clip to clamp off a bleeding
vessel. Not all ulcers need to be treated this way. The doctor doing the EGD will decide if
treatment is indicated based on the way the ulcer looks. The doctor will usually treat an ulcer
that is actually bleeding when it is seen and will also often treat other ulcers if they have a
certain appearance. These findings are sometimes called “stigmata of recent hemorrhage” or
just “stigmata”. Stigmata will usually get treated during the EGD if they are classified as high-
risk. Common high-risk findings include a “visible vessel” and an “adherent clot”.

Most ulcers can be treated and will heal. Often, people with ulcers will have to take PPIs for
several weeks to heal an ulcer. It is also important to correct what caused the ulcer. When
possible, NSAIDs should be stopped. Patients with ulcers caused by NSAIDs should talk to their
doctor about other medications that can be used to treat pain.

If the person is infected with H. pylori, then completing the full dose of antibiotics is very
important. Just as important, is making sure that the infection is gone. There are number of
ways to do this. Generally, a blood test is not a good way to test if the infection is gone. The
doctor who treated the infection can recommend the best way to do the “test of cure”.

People with gastric ulcers (only in the stomach) usually have another EGD several weeks after
treatment to make sure that the ulcer is gone. This is because a very small number of gastric
ulcers might contain cancer. Duodenal ulcers (at the beginning of the small intestine) usually
don’t need to be looked at again.

ETIOLOGY AND CLINICAL MANIFESTATIONS

The natural history of peptic ulcer disease ranges from resolution without intervention to the
development of complications such as bleeding and perforation. The pathogenesis is considered
as a combination of imbalance between defensive factors such as: prostaglandins, mucosal
blood flow, mucus-bicarbonate layer, cellular regeneration and aggravating factors such as:
hydrochloric acid, pepsin, bile salts, drugs and ethanol.

A peptic ulcer is a defect in the gastric or duodenal mucosa that extends through the muscularis
mucosa into the deeper layers of the wall. Peptic ulcers may present with dyspeptic or other
gastrointestinal symptoms, or may be initially asymptomatic and then present with
complications such as hemorrhage or perforation.

Asymptomatic

 Approximately 70 percent of peptic ulcers are asymptomatic. Patients with silent peptic ulcers
may later present with ulcer-related complications such as hemorrhage or perforation. Between
43 and 87 percent of patients with bleeding peptic ulcers present without antecedent dyspepsia
or other heralding gastrointestinal symptoms. Older adults and individuals on nonsteroidal anti-
inflammatory drugs are more likely to be asymptomatic from their ulcers and later present with
ulcer complications.

Symptomatic

Abdominal pain — Upper abdominal pain or discomfort is the most prominent symptom in

patients with peptic ulcers. Approximately 80 percent of patients with endoscopically diagnosed
ulcers have epigastric pain. Occasionally the discomfort localizes to the right or left upper
quadrants of the hypochondrium. Radiation of pain to the back may occur, but back pain as the
primary symptom is atypical. In untreated patients, pain can last a few weeks followed by
symptom-free periods of weeks or months. The "classic" pain of duodenal ulcers occurs two to
five hours after a meal when acid is secreted in the absence of a food buffer, and at night
(between about 11 PM and 2 AM) when the circadian pattern of acid secretion is maximal.

Patients with peptic ulcers, and particularly pyloric channel ulcers, may have food-provoked
symptoms due to visceral sensitization and gastroduodenal dysmotility. These symptoms
include epigastric pain that worsens with eating, postprandial belching and epigastric fullness,
early satiety, fatty food intolerance, nausea, and occasional vomiting.

Associated symptoms — Patients may have associated symptoms of bloating, abdominal

fullness, nausea, and early satiety that may be provoked by eating. Gastroesophageal reflux
may coexist but may or may not be related to the peptic ulcers.

PREVENTION

 Avoid foods that irritate your stomach. Use common sense: If it upsets your stomach when
you eat it, avoid it. Everyone is different, but spicy foods, citrus fruits, and fatty foods are
common irritants.
 Stop smoking. Heavy smokers are more likely to develop duodenal ulcers than nonsmokers.
 Practice moderation. Heavy consumption of alcohol and has been shown to contribute to
the development of ulcers, so keep your intake to a minimum. 
 Take nonsteroidal anti-inflammatory drugs (NSAIDS including aspirin and ibuprofen) with
food, as this may decrease your risk of irritating the lining of your stomach
 Learn how to control your stress levels. Regular exercise and mind-body relaxation
techniques (such as guided imagery and yoga or tai chi) are often helpful.
 CARE PLAN FOR A CLIENT DIAGNOSED WITH PEPTIC ULCER DISEASE

Peptic ulcer is an ulceration in the mucosal wall of the lower esophagus, stomach pylorus, or
duodenum. The ulcer may be referred to as duodenal, gastric, or esophageal, depending on its
location. The most common symptom of both gastric and duodenal ulcers is epigastric pain. It
is characterized by a burning sensation and usually occurs shortly after meals with gastric ulcer
and 2-3 hours afterward with duodenal ulcer.

Predisposing factors of peptic ulcer includes infection with the gram-negative bacteria

Helicobacter pylori which may be acquired through the ingestion of food and water, excessive
HCL secretion in the stomach, chronic use of non-steroidal anti-inflammatory drugs (NSAIDs)
which weakens the lining of the GI tract by reducing the protective function of the mucosal
layer, increased stress associated with illness and surgery, alcohol ingestion and excessive
cigarette smoking.

NURSING CARE PLAN

The nursing goals of a client with a peptic ulcer disease include reducing or eliminating
contributing factors, promoting comfort measures, promoting optimal nutrition,
decreasing anxiety with increased knowledge of disease, management, and prevention of ulcer
recurrence and preventing complications.

Here are one example of nursing care plans (NCP) and nursing diagnosis for
patients with peptic ulcer disease:

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

May be related to

 Fear of the unknown

 Nature of the disease.
 Situational crisis
 Stress
Possibly evidenced by

 Abdominal pain
 Apprehensive
 Expressed concerns about changes in life events
 Fatigue
 Irritability
Desired Outcomes
 Client will demonstrate ways of reducing anxiety level.

Reference

https://nurseslabs.com/peptic-ulcer-disease-nursing-care-plans/